Welcome everyone to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. 

What has been on my mind since I began Performance Medicine in 2007 is weight loss. Not that I had weight to lose, but because I knew that excess weight causes health problems that affect nearly every part of the body: brain, blood vessels, heart, liver, gallbladder, bone, joints, which can lead to high risk of Type 2 Diabetes, high blood pressure, heart disease, stroke, sleep apnea, metabolic syndrome, fatty liver disease, and osteoarthritis.  

All to say, when I meet someone who also sees “the writing on the wall” and is doing something about it, I take note! Enter Dr. Ashley Lucas, founder of PhD Weight Loss and author of 5 STEPS TO RESET THE SCALE. I met her a couple of months ago at her clinic in Asheville and saw for myself how her approach to weight loss is changing people’s lives. One of my patients had lost over 100 pounds on her program, which gave me even more reason to have her on The Common Sense MD to share her story.  


About Dr. Ashley Lucas


Dr. Lucas is a PhD in Sports Nutrition and Chronic Disease Registered Dietician. 

At the beginning of the podcast, Dr. Lucas shared her personal battle with weight. Before the PhD and RD, she was a world class, professional ballet dancer. As a dancer, she was passionate in her pursuit of perfection which meant constant rigorous training, and obsessively trying to match a ballet-specific body type. Even though she was extremely lean, she often heard, “you’re too fat”. 

Dr. Lucas fought through the adversity and ultimately danced her way into multiple professional ballet companies. Unfortunately, her dancing career came to an end when she was chosen to perform in New York City and instead of finding herself in the spotlight of a once in a lifetime performance, she landed in the ER. After multiple tests (thinking she was having a heart attack), the neurologist came back and told her she was underfed and over exercised. 

As a result, Dr. Lucas retired from her professional dancing career and went on to get her PhD in sports nutrition and chronic disease. She knew how significant a lack of nutrition was to her own sport performance and wanted to help others. A fascinating beginning to a fascinating approach to weight loss and nutrition.  


PhD Weight Loss 


When I formed Performance Medicine, it was for the sole purpose of helping obese patients get leaner. I knew nothing about nutrition, even though I had two (of three) children with Type 1 Diabetes. I had to start from scratch because what they taught me in medical school was completely wrong.  

Weight loss is complex. It’s physical AND mental, with a lot of other complexities added in. It’s much more than calories in/calories out. We’ve all heard “just eat less and exercise more”, but that doesn’t always work. Our bodies are not monitored by calorie sensors. We have hormones, metabolism and all sorts of mental and emotional aspects that play into it.  

On the podcast, I asked Dr. Ashley how she would approach a patient who is 100 pounds overweight. Her words were very straightforward… 

  1. It’s not your fault. 
  2. It’s not laziness or lack of willpower.
  3. Weight is driven by metabolism and (for some) addiction. 
  4. Let’s work together (TEAM) on a plan to get the weight off as fast as possible. 

Losing a half pound a week is healthy, but it takes forever! People often get diet fatigue and give up before they’ve made any dramatic change to their metabolism. All the weight comes back. There’s actually a lot of research out there showing that speedier weight loss is actually more effective, plus you’re more likely to keep it off. Note: I have believed in this philosophy for years! I like fast weight loss! 


Getting Rid Of Visceral Fat 


Most of the men in the PhD Weight Loss program drop about three to five pounds per week, and most of the women, two to three pounds. They do this by first understanding the body and visceral fat. 

Dr. Lucas said that with weight loss, most people don’t look at what’s happening physiologically in the body. Part of creating her program involved a deep dive into visceral fat and looking at what the fat cells are doing. I loved her description. 

Enter Dr. Ashley:

We know that the fat cell in the belly is different from the fat cells throughout the rest of the body. It’s called visceral fat. Visceral fat fills up the organs and wraps around it like a straight jacket. If you’re carrying fat in your belly and you take a slice of your liver, it looks like a Kobe beef steak. The (visceral) fat gets in there, grows its own blood vessels, gets its own oxygen supply, and starts to secrete its own hormones. It’s like a tumor. It secretes interleukin 6, which is your inflammatory hormone (i.e., joint pain, fatigue, and even skin irritation). We’ll have so many clients come in with autoimmune conditions, and the symptoms of those almost completely resolve through dropping weight. All because you’re reducing those inflammatory hormones in the body. 

We (at PhD Weight Loss) measure visceral fat. We’ve got to make sure that you fully collapse it, because if you only drop a portion of that excess fat weight, it’s like shaving the top off of a weed and leaving the root. It’s all going to come back. That’s why we see this yo-yo phenomenon happening all the time. Most people just choose some ambiguous number. They  want to drop maybe 15 or 20 pounds of that true 50 pound fat mass, and it all comes back! It’s not your fault. It’s not that you failed. It’s just that metabolically, your body hasn’t gotten to its sweet spot. For those carrying around this excess fat weight, your metabolism is slow. It’s sluggish. All your body wants to do is get fatter, as fast as possible. 


Non-Negotiables and Routine  


I’m fascinated by Dr. Lucas’ approach to visceral adiposity, and also love the way she talks about routine and non-negotiables (how they have to go together). 

Enter Dr. Ashley: 

My non-negotiables are that I move my body every day, not five days a week, but seven days a week. It is a non-negotiable for me to move somehow. I’ve made it so familiar that it feels really uncomfortable if I don’t get that in. One of my other non-negotiables is getting 30 grams of protein in my first meal of the day. 

These are two really good non-negotiables. I believe that most people don’t get enough protein. What are your non-negotiables? 


Philosophy and Meal Plan


PhD Weight Loss creates a customized meal plan for each of their clients. They also have a unique perspective on carbohydrates that I really connected with. 

Enter Dr. Ashley: 

We create a customized meal plan for each person, guiding them on exactly what, when, and how much to eat. It’s very clear. We take out all of the guesswork and make it really simple. There’s no lifestyle that we haven’t been able to support. 

Eighty percent of any change comes from the mind. There’s the mental and emotional habit behavior that needs to be addressed. So many programs out there prescribe medications or injections, tell you what you should and shouldn’t eat, but don’t tackle the mindset. I have found that if the weight drops and the emotional issues don’t go with it, the weight will not stay off. 

The mind takes work. At PhD Weight Loss, we have weekly one-on-one coaching. We are not therapists. We are coaches. We stack wins, we create new behaviors. If there is a deep trauma in a client’s past that needs to be addressed, we recommend a certified, licensed therapist to help them.

The PhD Meal Plan: Our meal plan is focused on finding each person’s carbohydrate tolerance level. Our bodies tolerate carbohydrates differently. If you come from a genetic predisposition of Type 2 Diabetes, morbid obesity, then your carbohydrate tolerance level is going to be lower. If you’ve struggled with significant weight gain in your past, your tolerance is going to be lower. So we never say you need to be at 50 grams of carbs or 200 grams of carbs per day. Our job is to figure out, from your unique situation, how many grams of carbs your body is able to tolerate. 


Final Thoughts 


At the end of our conversation, Dr. Lucas shared a weight loss tip that could easily become another episode: 


The first meal is either going to send the body on a blood glucose rollercoaster of highs and lows, or it’s not. Note: You don’t want glucose spikes because they create stress in the body, causing glycation and more free radicals

The first meal doesn’t necessarily have to be in the morning, nor does it have to be breakfast food. A suggestion was something savory like eggs, or an omelet with vegetables. Maybe a full plain greek yogurt. As she said above, one of her non-negotiables is getting 30 grams of protein in the first meal. I agree, you definitely need to get protein in this first meal. Note: My first meal of the day does not take place until 11 or 12 PM because I like intermittent fasting. This is my philosophy for my own system. Some people may need to eat breakfast. 

It was great having Dr. Lucas on the podcast. I hope you will check out the full conversation on the Performance Medicine YouTube channel, or listen to the podcast. There’s more between these lines! Also, if you want to learn more about how her program works, where she is located, etc, you can check out her website myphdweightloss.com

There is HOPE. There are SOLUTIONS. I encourage each of you to read 5 STEPS TO RESET THE SCALE by Dr. Ashley Lucas, RD, and start believing that weight gain is NOT your fault. You CAN get the weight off for good! 

Stay educated. Stay healthy. 

Till next week.